MEDICARE: MARIA LOURDES ANCHETA PALMA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	11714	NC
2	2251P0200X	Pediatric Physical Therapist	P11714	NC

General Provider Information

NPI Number	:	1477033611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA LOURDES ANCHETA PALMA PT

Provider Business Mailing Address
First Line	:	302 WYNBROOKEE LN
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-8679
Country	:	US
Telephone Number	:	252-224-1012
Fax Number	:

Provider Business Practice Location Address
First Line	:	6976 DODDRIDGE LN
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27519-4534
Country	:	US
Telephone Number	:	910-604-2650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2018
Last Update Date	:	05/29/2026

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